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Indigenous Cultural Safety, Cultural Humility, and Anti-Racism

​​​This standard applies to LPNs, NPs, RMs, RNs, and RPNs​.​​​​​​​​​​​​​​​​

Practice standards set out requirements related to specific aspects of nurses' and midwives' practice. They link with other standards, policies, and bylaws of the BC College of Nurses and Midwives, and all legislation relev​​ant to nursing and midwifery practice.


In Plain Sight: Addressing Indigenous-specif​​ic Racism and Discrimination in B.C. Health Care​ provides evidence of Indigenous-specific1 racism in the B.C. health care system. Indigenous-specific racism and discrimination negatively affects Indigenous clients’ access to health care ​and health outcomes. These impacts include lower life expectancy, higher infant mortality, and the increased presence of chronic health conditions.2​​

The purpose of this standard is to set c​​lear expectations for how BCCNM registrants are to provide culturally safe and anti-racist care for Indigenous clients.

This standard is organized into six ​​core concepts. Within these concepts are the principles to which nurses and midwives are held. 

Core concepts & princ​​iples 

1.​ ​​​Self-reflective practice (it starts with me)

Cultural humility begins with a self-examination of the nurse or midwife’s values, assumptions, beliefs, and privileges embedded in their own knowledge and practice, and considerati​​on of how this may impact the therapeutic relationship with Indigenous clients. Cultural humility promotes relationships based on respect, open and effective dialogue, and mutual decision-making.


Nurses and midwiv​es:


​Reflect on, identify, and do not act on any stereotypes or assumptions​​​ they may hold about Indigenous peoples.


​Reflect on how their privileges, biases, values, belief structures, behaviours, a​​nd positions of power may impact the therapeutic relationship with Indigenous clients. 


​Evaluate and seek feedback on their own behaviour towards Indigeno​​us peoples.​

2. Building knowledge through education

Nurses and midwives continually seek to impro​​ve their ability to provide culturally safe care for Indigenous clients.


Nurses and midwives:​


​Undertake ongoing education on Indigenous health care, determinants of health, cultural safety, cultural humility, and anti-racism.​


​Learn about the negative​​ impact of Indigenous-specific racism on Indigenous clients accessing the health care system, and its disproportionate impact on Indigenous women and girls and two-spirit, queer, and trans Indigenous people.3


​Learn about the historical and current impacts of colonialism on Indigenous people and how this may impact their health care​​ experiences.


​Learn about the Indi​​genous communities located in the areas where they work, recognizing that languages, histories, heritage, cultural practices, and systems of knowledge may di​ffer between Indigenous communities.

​3. Anti-racist practice (taking action) 

Nurses and midwives take active steps to identify, address, prevent, and e​liminate Indigenous-specific racism. 


Nurses and mid​wives:


Take appropriate action when they observe others acting in a racist or discriminatory manner towards Indigenous people by:​​​​​​​


​Helping colleagues to identify and eliminate racist attitudes, languag​​e, or behaviour.


​Supporting client​s, colleagues and others who experience and/or report acts of racism.


​Reporting acts of racism to leadership and/or the relevant health regu​​latory college.

​4. Creating safe health care experiences

Nurses ​and midwives facilitate safe health care experiences where Indigenous clients’ physical, mental/emotional, spiritual, and cultural needs can be met. 


Nurses and midwives:


Treat clie​​nts with res​​pect and empathy by: ​


​Acknowledging​​ the client’s cultural identity.


​Listening to and see​king to understand the client’s lived experiences.


​Treating client​​s and their families with compassion.


​Being open to le​arning from the client and others.


Care for a client holistically,​ considering their physical, mental/emotional, spiritual, and cultural needs.​


​Acknowledge and incorporate into the plan of care Indigenous cultural rights, values, and practices, including ceremonies and protocols r​​elated to illness, birth, and death, where able.


Facilitate the involvement of the client’s family and others (e.g., community and Elders, Indigenous cultural navigators, and interpreters) as needed and requested.​​

5.​ P​erson-led care (relational care)

Nurses and mid​​wives work collaboratively with Indigenous clients to meet the client’s health and wellness goals. 


Nurses and mid​wives:


​​​Respectfully learn a​​bout the client and the reasons the client has sought health care services.


​Engage with clients and their identified supports to identify, understand, and ad​​dress the client’s health and wellness goals.


​​Actively support th​​e client’s right to decide on their course of care.


​Communicate effective​ly with clients by:


​​Providing the client with the necessary time and space to shar​​e their needs and goals.


​Providing clear information about the health care options available, including information about what the client may exp​​erience during the health care encounter.


​Ensuring information is communicated in a way that the client can underst​​and.

​6. Strengths-based and trauma-informed practice (looking below the surface)

Nurses and midwives have knowledge about different types of trauma an​​d their impact on Indigenous clients, including how intergenerational and historical trauma affects many Indigenous people during health care experiences. Nurses and midwives focus on the resilience and strength the client brings to the health care encounter.  


Nurses an​d midwives:


​Work with the client​ to incorporate their personal strengths that will support the achievement of their health and wellness goals.


​Recognize the potential for trauma (personal or intergenerational) in a client’s life and adapt their approach to be thoughtful ​​and respectful of this, including seeking permission before engaging in assessments or treatments.


​Recognize that colonialism and trauma may affect how clients view, acc​​ess, and interact with the health care system.


​Recognize that Indigenous women, girls, two-spirit, queer, and trans Indigenous people are disproportionately impacted by Indigenous-specific racism in the health care system and consider the impact gender-specific trauma may have on the client.​​​


​​In this standard, “Indigenous” refers to First Nations, Métis, and Inuit Peoples in Canada.​
​Turpel-Lafond, M.E. (2021). In plain sight: addressing Indigenous-specific racism and discrimination in B.C. health care. Queen’s Printer: Victoria, BC. pg. 37.
​Turpel-Lafond, M.E. (2021). pg. 72.

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We acknowledge the rights and title of the First Nations on whose collective unceded territories encompass the land base colonially known as British Columbia. We give specific thanks to the hən̓q̓əmin̓əm̓ speaking peoples the xʷməθkʷəy̓əm (Musqueam) and sel̓íl̓witulh (Tsleil-Waututh) Nations and the Sḵwx̱wú7mesh-ulh Sníchim speaking Peoples the Sḵwx̱wú7mesh Úxwumixw (Squamish Nation), on whose unceded territories BCCNM’s office is located. We also give thanks for the medicines of these territories and recognize that laws, governance, and health systems tied to these lands and waters have existed here for over 9000 years.

We also acknowledge the unique and distinct rights, including rights to health and wellness, of First Nations, Métis, and Inuit peoples from elsewhere in Canada who now live in British Columbia. As leaders in the settler health system, we acknowledge our responsibilities to these rights under international, national, and provincial law.​